Long-term outcomes of wrist procedures and treatments in adults: A Systematic review of durability, complications, and patient satisfaction

Introduction Wrist procedures—including prosthetic implantation, internal fixation, and adjunctive therapies—aim to improve function and alleviate pain in adults with arthritis, complex fractures, and degenerative osteoarthritis. Despite advances in implant design and surgical techniques, long-term outcomes remain unpredictable due to complications such as loosening, implant fracture, and fixation failure. Objective We conducted a systematic review to evaluate long-term outcomes of adult wrist procedures and treatments, emphasizing implant durability, complication rates, and patient satisfaction. Methods We searched PubMed, Embase, and Cochrane without language or date restrictions for randomized clinical trials and observational studies that enrolled at least ten adult patients undergoing wrist procedures (including prosthetic arthroplasty, fixation methods, and adjunctive interventions). We extracted data on time to implant or fixation failure, complication incidence, and patient-reported outcomes (DASH and VAS scores). Two independent reviewers screened titles, abstracts, and full texts and assessed risk of bias using RoB 2.0 and the Newcastle–Ottawa Scale. Results Eight studies (1,351 participants) met inclusion criteria. In one prosthesis-focused cohort, the Universal 2 implant demonstrated a 78% survival rate at 10 years but experienced high rates of loosening and implant fracture (52%). Across fixation and surgical trials, functional scores (DASH) improved from a mean of 85 to 52 points (p < 0.05) over 5 years. However, up to one-third of patients required surgical revision due to mechanical failures or complications. Cryotherapy trials reduced in-hospital analgesic use but did not significantly alter long-term pain scores. Discussion Although wrist prostheses and fixation strategies often yield early gains in mobility and pain relief, mechanical complications limit their long-term success. Reported survival and revision rates align with prior literature, underscoring an urgent need for more durable materials, improved fixation techniques, and standardized outcome metrics. Variability in study design and heterogeneous use of PROMs (DASH vs. PRWE) hinder direct comparisons.